Have diabetes and fed up with people who don't have diabetes 'sticking their oar in' whether in a kind meaning way or not? Yeah, so was Dr Polonsky and he came up with some diabetes etiquette which I am happy to share with you. Feel free to share with your non diabetic friends :)

Here are Dr. Polonsky's 10 etiquette tips for people without diabetes, written from the perspective of someone with diabetes:

• 1 - DON'T offer unsolicited advice about my eating or other aspects of diabetes. You may mean well, but giving advice about someone's personal habits, especially when it is not requested, isn't very nice. Besides, many of the popularly held beliefs about diabetes ("you should just stop eating sugar") are out of date or just plain wrong.
• 2 - DO realize and appreciate that diabetes is hard work. Diabetes management is a full-time job that I didn't apply for, didn't want, and can't quit. It involves thinking about what, when, and how much I eat, while also factoring in exercise, medication, stress, blood sugar monitoring, and so much more - each and every day.
• 3 - DON'T tell me horror stories about your grandmother or other people with diabetes you have heard about. Diabetes is scary enough, and stories like these are not reassuring! Besides, we now know that with good management, odds are good you can live a long, healthy, and happy life with diabetes.
• 4 - DO offer to join me in making healthy lifestyle changes. Not having to be alone with efforts to change, like starting an exercise program, is one of the most powerful ways that you can be helpful. After all, healthy lifestyle changes can benefit everyone!
• 5 - DON'T look so horrified when I check my blood sugars or give myself an injection. It is not a lot of fun for me either. Checking blood sugars and taking medications are things I must do to manage diabetes well. If I have to hide while I do so, it makes it much harder for me.
• 6 - DO ask how you might be helpful. If you want to be supportive, there may be lots of little things I would probably appreciate your help with. However, what I really need may be very different than what you think I need, so please ask first.
• 7 - DON'T offer thoughtless reassurances. When you first learn about my diabetes, you may want to reassure me by saying things like, "Hey, it could be worse; you could have cancer!" This won't make me feel better. And the implicit message seems to be that diabetes is no big deal. However, diabetes (like cancer) IS a big deal.
• 8 - DO be supportive of my efforts for self-care. Help me set up an environment for success by supporting healthy food choices. Please honor my decision to decline a particular food, even when you really want me to try it. You are most helpful when you are not being a source of unnecessary temptation.
• 9 - DON'T peek at or comment on my blood glucose numbers without asking me first. These numbers are private unless I choose to share them. It is normal to have numbers that are sometimes too low or too high. Your unsolicited comments about these numbers can add to the disappointment, frustration, and anger I already feel.
• 10 - DO offer your love and encouragement. As I work hard to manage diabetes successfully, sometimes just knowing that you care can be very helpful and motivating.

Understanding Blood Glucose levels


So you are newly diagnosed as a diabetic and you know that you have to monitor your blood sugar levels, and you know this because the Doctor told you that.

But what you don’t know is what it actually means. This should help.


Blood sugar concentration, (or in reality glucose level), refers to the amount of glucose present in your blood. Normally the blood glucose level is maintained at a reference range between about 3.6 and 5.8 mM (mmol/l). It is tightly regulated as a part of metabolic homeostasis.

WTF? Exactly what does that mean?

metabolic homeostasis basically means keeping (or regulating) the internal systems so as to keep a stable condition.

Mmol/L is the standard unit of measurement and refers to micro moles per litre and you don’t need to understand the chemistry but in case you want to know:

SCIENCE BIT:
Average normal blood glucose levels in humans are about 5mM (mmol/l) this is because the molecular weight of glucose, C6H12O6, is about 180 g/mol). The total amount of glucose normally in circulating human blood is about 3.3 to 7g – because an average human contains about 5 litres of blood. (That is just over a gallon in old money). Glucose levels vary a little during the day, rising after meals for an hour or two by a few grams and are usually lowest in the morning, before the first meal of the day (unless you are a secret midnight snacker).


So, what is this GLUCOSE stuff? Well it is carried by the bloodstream from the intestines or liver to body cells, it is the primary source of energy for body's cells, fats and oils (ie, lipids) being primarily a compact energy store, kind of like a battery. It really doesn’t mean that you should stop eating sugar, it means that you need to better control the type of food that you eat. But that is a separate story.

Failure to maintain blood glucose in the normal range leads to conditions of persistently high (hyperglycemia) or low (hypoglycemia) blood sugar. And that means that your body is not maintaining metabolic homeostasis.

A diabetic fails to maintain metabolic homeostasis and normally is hyperglycaemic and has very high glucose levels and this is often characterised by a constant thirst, with the resultant frequent trips to the loo.

Earlier on in treatment, a diabetic may also start to suffer hypoglycaemic attacks. This is often because the medication has not returned the body to stability and may well be over compensating.

So, at first, you really need to monitor your blood glucose levels, and map it against the food that you eat. That way you can see the effects of what you eat and the medication that you take.

As Alexandr would say ‘Simples’

More on the drug scare - a good explanation I thought

A group of drugs commonly used for diabetes carry an increased risk of heart problems and death when compared with a different type of diabetes drug, researchers have found.

Their study found that people taking drugs called sulphonylureas are more likely to have heart attacks, heart failure or die, compared to people taking another popular diabetes drug called metformin. Doctors should choose metformin when treating people with diabetes, unless they can't take it or it doesn't work for them, say the researchers.

What do we know already?

If you have type 2 diabetes, it means you have too much glucose in your blood. This can damage your blood vessels, causing heart attacks and strokes, as well as damage to smaller blood vessels in your kidneys, feet, and eyes. Some people with type 2 diabetes control their blood glucose through diet and exercise, but most people need diabetes medicines.

The most commonly used drugs are metformin (brand name Glucophage), and a group of medicines called sulphonylureas. Sulphonyureas include the medicines chlorpropamide, glimepiride (Amaryl), glipizide (Glibenese, Minodiab), tolbutamide, glibenclamide (Daonil, Euglucon), and gliclazide (Diamicron).

Another group called glitazones (also known as thiazolidinediones) are also used. There are two types: rosiglitazone (Avandia) and pioglitazone (Actos).

These medicines all help keep your blood glucose under control, although they work in different ways.

Lately, there's been concern that some of these drugs might increase your chances of having a heart attack or getting heart failure (where the heart can't pump blood efficiently). It's hard to pick up these problems in the clinical studies that are done before drugs are licensed, because they may take a long time to happen, and you need to test very large groups of people to pick up these sorts of differences in risk.

This new study looked at the risks of having a heart attack, getting heart failure, or dying for any reason while taking one or more of the commonly used diabetes drugs. The researchers used figures from a big database of prescribing information, cross-checked with patient records. They compared each type of drug with metformin, because metformin is a well-established diabetes drug that tends to be used first for people with diabetes.

What does the new study say?

The study found that people were more likely to die of any cause, or to get heart failure, while taking a sulphonylurea drug, compared with while taking metformin. They were also more likely to have a heart attack, although this link was not as strong.

It's hard to say exactly how big the difference is. That's because the researchers analysed the results in different ways. Using one set of calculations, the researchers said sulphonylureas were linked to a 60 percent increased risk of death, while using another set, the increased risk was 24 percent.

Of the two glitazone drugs, pioglitazone seemed to be better than rosiglitazone, although the researchers say they need to see more studies to be sure of this. People were less likely to die of any cause while taking pioglitazone, compared with while taking rosiglitazone or metformin. Neither pioglitazone nor rosiglitazone was linked to more deaths or heart attacks than metformin, although rosiglitazone was linked to an increased chance of heart failure. Doctors are already warned not to prescribe rosiglitazone for people at risk of heart failure.

It's important to remember that the study didn't compare the drugs with no treatment. So, it didn't say that people were more likely to die while taking sulphonylureas compared with taking nothing at all. The study may simply show that metformin works better than sulphonylureas.

How reliable are the findings?

The good points of this study are that it covered a lot of people (more than 90,000) over an average of 7 years each. Because of the way the data was recorded, we can compare the risks and benefits of treatments as they're actually prescribed, taking account of the fact that people tend to take more than one drug, or move from one drug to another over time.

However, this makes it harder to account for all the different factors that could affect the results. For example, people might only take sulphonylurea drugs after they'd tried metformin, and it hadn't worked well enough for them, or because they have kidney disease (people with kidney disease can't take metformin). That might mean that people who took sulphonylureas were sicker than people who took metformin, so more likely to die of any cause.

Also, the study relies on all the information on the databases being correctly entered at the time. Because this was a 'real world' study, rather than set up by researchers from the start, there's likely to be more human error in terms of recording data than in a clinical trial.

Where does the study come from?

The study was done by a team of researchers based at Imperial College in London, UK. It was published in the BMJ (British Medical Journal). The study was not directly funded by anyone, although some of the researchers received grants from various research programmes.

What does this mean for me?

If you are taking a sulphonylurea drug, the results of the study might sound alarming. But they may be less alarming than they sound. The study doesn't show that these drugs are actively doing you harm. If they reduce your glucose levels, they protect you against potential problems with your eyes, nerve endings, and feet, as well as treating symptoms such as thirst and tiredness.

What the study shows is that they may not be reducing your overall risk of having a heart attack, heart failure, or dying for any other reason, compared with metformin. Previous studies have shown that metformin seems to reduce the chances of having a heart attack or dying in people with diabetes, especially if you're overweight.

Doctors in the UK are advised to prescribe metformin first for patients with diabetes, although they are told to consider a sulphonylurea in some groups of patients. According to national guidelines, sulphonylureas work faster, so may be used when a quick treatment is needed, and may also be more suitable for patients who are not overweight.

What should I do now?

All diabetes medicines protect against the problems you get from having too much glucose in your blood. It's important not to stop taking medicines without talking to your doctor first.

If you have diabetes and you haven't been treated with metformin before, it may be worth discussing this with your doctor, especially if you're overweight.

A new diabetic drug scare - sulphonylurea increases the risk of heart disease. Well, hello!!! Diabetes increases the risk of heart disease and of losing eyesight and amputation and stroke. The bloody disease is far worse than the cure.

Mind you, quite please I am not taking it at the moment I am on Metformin and Vildagliptin, how long before they say that vildagliptin causes problems and withdraw that?

There is a story in the NHS here, and it has links to the daily telegraph and Daily Mirror stories.

From Diabetes Health

Q & A: How To Lower Your Blood Sugar When It's Over 200 mg/dl

Nov 21, 2009

Q: How do I lower my blood sugar when it goes over 200 mg/dl? I have type 2 diabetes.

A: An excellent question, but a complicated one to answer. Your doctor or nurse educator should be contacted whenever your blood sugar runs consistently higher than 250 mg/dl for more than two days. When a person with type 2 diabetes encounters a high blood sugar, the strategy used to bring it down will vary from individual to individual. This is because of differences in treatment involving diet, exercise, and medication. It will also depend upon the guidelines for glucose control that you and your doctor have mutually agreed upon.

When high blood sugars do occur, there are a number of strategies that can be employed to lower the glucose level back down to a normal range. These might include:

1) Eating less food at the next meal, eliminating a snack, and/or eating foods with a lower glycemic index.

A general rule of thumb to follow is to eliminate 15 grams of carbohydrate (the amount in one starch exchange, one fruit exchange, or one cup of skim milk exchange), which will lower blood glucose by 30 mg/dl. If you test your blood sugar at 182 mg/dl before a meal or snack, then eliminate one starch and one cup of milk at the next meal to bring the glucose value close to 120 mg/dl as a baseline. Although people with diabetes will respond differently to this adjustment, it provides a basic guideline to start with.

For persons with type 2 diabetes who are overweight, the loss of only five to 10 percent of total weight can dramatically improve blood glucose values. Consequently, just cutting calories moderately can achieve better blood glucose control.

Lastly, choosing foods with a lower glycemic index, that is, foods that do not raise blood sugar as quickly or dramatically, can help to bring blood glucose back into a normal range. Some examples of foods with a low glycemic index are dried beans and lentils.

To test the glycemic effect of a food on your system, you will need to do more frequent monitoring. For example, you may want to compare the effect of brown rice versus baked potato by eating equivalent carbohydrate amounts of these foods at dinner and comparing your blood glucose response two hours later. The exact effect will vary from person to person.

2) Increasing activity or incorporating more exercise.

Persons with type 2 diabetes generally respond to increased exercise with a lowered blood glucose value. Simple exercise, such as walking 20 minutes or more per day, can effectively improve glucose tolerance and induce weight loss. Proper exercise can actually be effective enough to lower or completely eliminate the need for medication altogether.

3) Increasing medications, changing medications, and/or administering them more frequently.

Although this is certainly an option, it makes more sense to first address the problem of elevated blood glucose by exercise and cutting back on food. These measures are less costly and have fewer side effects. If they aren't effective, however, a medication change may be indicated. If you are on the minimal dose of oral agents, your doctor might raise the dose or split it into morning and evening doses.

This could also be true for those using insulin. Taking more shots per day does not mean that your diabetes is worse. It may even bring more flexibility into your lifestyle. In fact, a rule of thumb for those on insulin (check with your doctor first before making these adjustments) is to take one unit of regular insulin to lower blood glucose 30 mg/dl. If your blood sugar is 191 mg/dl before a meal, an extra three units of insulin will bring the glucose down about 100 mg/dl.

It is important to note that this rule may change for people who exercise regularly because it will take less insulin to achieve the desired effect. It may also change for those who become ill because they are more insulin-resistant and may need more insulin to achieve the desired effect. The effectiveness of insulin is also dramatically decreased by high blood sugar levels.

4) Using relaxation techniques and behavioral management.

Relaxation exercises, including deep breathing and audio tapes that guide you through deep muscle relaxation, can reduce stress and help you deal more effectively with it. Tapes are available specifically designed to create images of healthiness in diabetic individuals and encourage visualization of improved glucose control. Behavioral management techniques also increase one's overall sense of control over life and self-efficacy, so that diabetes becomes a state of "wellness in the midst of illness." When you are relaxed and in control, your blood glucose values can improve.

5) Treating identified illness and/or infections.

Illness and infection causes a rise in adrenergic hormones, which increase the production of glucose in the body. This extra surge of glucose is part of the healing process, but can upset glucose control. Thus, continuing to take medications despite poor appetite is vital. You may temporarily require more medication during periods of extended illness. Ask your doctor for instructions on dealing with illness.

6) Monitoring on a more frequent basis and/or monitoring other parameters.

When your blood glucose values exceed the target ranges established by you and your doctor, monitoring should be done every two hours until your blood glucose returns to normal. This gives you an opportunity to treat and adjust blood glucose as soon as possible, rather than waiting until your next doctor visit or next meal (which might be four or five hours later). It also tells you whether or not what you are doing is helping to bring the blood glucose down. Another step to take if your blood sugar is over 250 mg/dl would be ketone checks (done by urine dip stick or via a fingerstick to measure betahydroxybutyrate, an acid). Testing ketones hourly until they disappear is recommended.

7) Increasing consumption of sugar-free fluids.

Often, poor hydration accounts for the concentration of sugar in the blood. All people (with diabetes or not) should drink two to three quarts of sugar-free fluids per day. When glucose is elevated, drinking helps to dilute it. Also, drinking fluids is filling, decreasing the possibility of overeating.

People with heart disease who take diuretics and those with renal (kidney) complications may need to be on restricted fluids. Check with your doctor and/or dietitian if you fall into these special categories.

To combat high blood sugars, the most important strategy is prevention. Prevention of high blood sugars is usually possible with frequent and consistent monitoring. If you have awareness of your usual glucose response patterns to foods and exercise, it will be easier to plan out your day and prevent fluctuations in your blood sugar.

from Diabetes Health:

World Diabetes Day Is This Saturday, November 14, 2009

Kristin Lund
Nov 12, 2009

World Diabetes Day is a global awareness campaign that's celebrated every year on November 14. The goal is to encourage action to further the prevention, treatment, and care of diabetes, as well as to support the United Nations Resolution on Diabetes. Landmarks and monuments across the world are lit in blue to create a united voice for diabetes awareness, and diabetes events are held around the globe. As of Monday evening, November 9, the World Diabetes Day website reports that 366 registered diabetes events are scheduled for November 14^th, in countries ranging from Saudi Arabia to Argentina to Morocco. In addition, 623 monuments are being lit in blue around the globe. More are sure to be added to the list as the day draws closer and closer.

The U.N. Resolution on Diabetes focuses world attention on the need to stop the diabetes epidemic through urgent action. Governments need to promote low-cost strategies that alter diet, increase physical activity, and modify lifestyles in order to reverse the diabetes tide. According to the California Diabetes Program (DIRC) website, "For governments, [World Diabetes Day] is a call to implement effective strategies and policies for the prevention and management of diabetes to safeguard the health of their citizens with and at risk for diabetes."

Advocacy

The DIRC and the Centers for Disease Control and Prevention (CDC) have suggestions on how communities can help stop the epidemic, including increasing access to affordable healthy food and beverages. We need to advocate to:

1. Make healthy food and beverages more available and affordable and restrict availability of less healthy foods and beverages in public places such as schools, government buildings, libraries, and parks
2. Increase the number of grocery stores in low-income neighborhoods
3. Improve mechanisms for purchasing foods directly from local farms
4. Offer incentives to retailers to offer healthy food and beverage options
5. Limit advertising of less healthy foods and beverages
6. Encourage smaller portion sizes by food vendors
7. Discourage consumptions of sugar-sweetened beverages

Educate someone you know about the risks of diabetes

If you are unable to attend a World Diabetes Day event or to witness a monument or building being lit in blue, you can honor the day by educating someone else about the risks of diabetes. They are, according to the DIRC:

• Family history of diabetes
• Increasing age
• Obesity and a sedentary lifestyle
• Ethnicity
• History of diabetes during pregnancy or giving birth to a large baby
• Having high blood pressure or high cholesterol

Everyone can reduce the risk of type 2 diabetes by:

• Exercising
• Eating right
• Losing weight if needed
• Seeing your healthcare provider
• Getting your eyes checked

http://www.diabeteshealth.com/read/2009/11/07/6438/aace-releases-new-algorithm-for-treatment-of-type-2-diabetes/

The American Association of Clinical Endocrinologists have bought out new guidelines for the treatment of Type 2. I wonder if the UK guys follow similar guidelines?

Meanwhile whilst exploring other diabetes mellitus solutions beyond Metformin I have stumbled across Berberine, there is this report in the daily telegraph, and a quick google/bing bought up many other references. The dubiously reliable Wiki has a large sectrion on it here and it seems to have tremendous benefits, similar in effect to metformin, but with some added side effect benefits, such as inhibiting Stapphylococcus, fungal infections such as Candida, inhibits cancers such as Breast Cancer, and is a mild anti depressant. Looks like a wonder herb to me, yet a quick trawl of health foods shops doesn't readily find it listed. interesting?

Wonder if I should give it serious consideration and perhaps import it from China?